Switching to anidulafungin from caspofungin in cancer patients in the setting of liver dysfunction is associated with improvement of liver function tests.

ABSTRACT

BACKGROUND: Anidulafungin does not undergo hepatic metabolism like the other echinocandins. Therefore, there is a perception that anidulafungin may be less hepatotoxic or less likely to exacerbate existing liver damage. This has not been substantiated in the literature. METHODS: We retrospectively reviewed all cancer patients in whom anidulafungin treatment was immediately preceded by treatment with caspofungin and there existed clinical or laboratory evidence of hepatic damage or dysfunction at M. D. Anderson Cancer Center from January 2010 to December 2013. RESULTS: Sixty-one patients were included in the study. Most patients had haematological malignancies (58, 95%), and the patients were administered hepatotoxic agents such as chemotherapeutic agents (47, 77%) and other medications (38, 62%) simultaneously. There were significant decreases in AST and ALT (P < 0.029 and P < 0.0017, respectively) between two timepoints (switch from caspofungin to anidulafungin and end of anidulafungin therapy). The median changes in AST, ALT and total bilirubin during anidulafungin therapy were -43 IU/L, -25 IU/L and -0.15 mg/dL, respectively. Over 70% of patients had favourable changes in hepatic enzymes or function, and values were stable and decreased at the end of anidulafungin therapy. On average, the percentage of patients with laboratory results meeting common terminology criteria for adverse events (CTCAE) grade ≥2 at the time of switching to anidulafungin was decreased at the end of treatment. CONCLUSIONS: Median serum values and trajectory of hepatic enzymes and hepatotoxicity usually decreased after switching to anidulafungin treatment in patients with abnormal liver function tests. Anidulafungin could be useful in the management of cancer patients with hepatotoxicity occurring during caspofungin therapy.